Lacrimal Surgery

Lacrimal Surgery

Miles treats all causes of watery eye. For those patients with a blocked tear duct (nasolacrimal duct obstruction) he performs scar sparing tear drainage surgery via the nose (endonasal DCR surgery) where possible.

He offers the following procedures:

  • Endonasal dacryocystorhinostomy (scarless tear drainage repair)

  • External dacryocystorhinostomy (traditional tear drainage surgery)

  • Syringing and probing for congenital nasolacrimal duct obstruction (with and without silicone intubation)

  • Lacrimal bypass surgery (Lester Jones Tube insertion)

What is Endonasal DCR Surgery?

Endonasal Dacryocystorhinostomy (DCR) is a surgical procedure to treat blocked tear ducts. It creates a new tear drainage pathway from the lacrimal sac (tear sac) to the inside of the nose, bypassing the blocked area. This method is performed through the nasal passage without an external incision.

Who Needs Endonasal DCR Surgery?

Patients with chronic tearing (epiphora) or recurrent eye infections due to a blocked nasolacrimal duct may benefit from this surgery. Miles will determine if this procedure is right for you based on your symptoms and diagnostic tests.

Preparing for Surgery

  1. Pre-Operative Assessment: A thorough eye examination will be conducted.

  2. Medical History: Inform your surgeon about any medications you are taking and your medical history.

  3. Pre-Surgery Instructions: Follow any guidelines provided by your healthcare team, such as fasting before surgery.

The Surgery Procedure

  1. Anesthesia: General anesthesia is used for endoscopic DCR surgery.

  2. Endoscopic Access: A small endoscope is inserted into the nasal passage to provide visual access to the tear duct system.

  3. Creating a New Pathway: A new drainage passage is created between the lacrimal sac and the nasal cavity.

  4. Stenting: Small silicone tubes will be temporarily placed to keep the new passage open during healing.

Recovery After Surgery

  1. Rest: Take it easy for a few days and avoid strenuous activities.

  2. Nasal Care: Follow instructions for nasal irrigation to keep the area clean.

  3. Eye Drops and Nasal Sprays: Use prescribed medications to prevent infection and reduce inflammation.

  4. Follow-Up Appointments: Attend all follow-up visits to monitor healing and remove stents if placed.

  5. Avoid Nose Blowing: Refrain from blowing your nose for at least a week after surgery to prevent disrupting the surgical site.

Potential Risks and Complications

While endonasal DCR is generally safe, potential risks include bleeding, infection, scarring, and recurrence of tear duct obstruction.

Benefits of Endonasal DCR Surgery

  • Resolves chronic tearing (epiphora)

  • Reduces recurrent eye infections

  • Minimally invasive with no external scars

  • Shorter recovery time compared to external DCR

Frequently asked questions

  • The procedure typically takes about 60 minutes. But you should expect to be at the surgical centre for the day.

  • You will be under anesthesia during the procedure, so you should not feel pain. Post-operative discomfort is usually minimal and can be controlled with simple analgesia.

  • Most patients can resume normal activities after a week, but it’s important to follow your surgeon’s specific recommendations.

  • Infection

    Post operative infection is very rare and can usually be managed with antibiotics.

    Bleeding

    Some bleeding from the nose following DCR surgery is normal and expected. Miles usually inserts a small dissolvable dressing into the nose at the time of surgery to help prevent this. Nose bleeds following surgery can nearly always be managed at home.

    Failure of surgery

    DCR surgery is typically successful in around 90% of cases but occasionally the eye may continue to water and further treatment might be indicated.

Miles is a consultant ophthalmologist and oculoplastic surgeon with a private practice at The London Clinic on Harley Street. He specialises in ophthalmic cosmetic, reconstructive, and lacrimal (tear drainage) surgery.

In addition to his private practice, Miles holds a substantive NHS consultant post at the Royal Free London and he established and runs the oculoplastic service at North Middlesex University Hospital. He also has expertise in cataract and pterygium surgery.

As an honorary clinical lecturer at UCL and assistant professor at St. George's University, Miles is actively involved in training the next generation of ophthalmologists.